yeganeh pasebani

The global SARS-CoV-2 pandemic has disrupted health systems and put a huge strain on hospitals and healthcare workers. Prioritizing COVID-19 patients in hospitals caused irreversible harm to cardiac patients. Although multiple studies have shown that ST-segment elevation myocardial infarction (STEMI) patients have worse admission circumstances than before the pandemic, the hospital outcomes of these patients have remained limited. This systematic review and meta-analysis examined STEMI patient outcomes during the COVID-19 epidemic.

We conducted systematic searches of MEDLINE (through PubMed), Web of Science, Scopus, and Embase through Jan 10, 2021. All studies with reporting in-hospital mortality, length of stay, and door-to-balloon time with over twenty participants were included. Articles without clear definitions or results were excluded. The study followed PRISMA guidelines. The outcomes of interest were door-to-balloon time, death, and hospital stay during COVID-19 pandemic compared prior.

Our meta-analysis included 12 studies and 21170 people (115-6609). The pooled analysis showed significantly more pandemic mortality (OR=1.24; 95% CI: 1.07-1.43). Ten studies (13,091) recorded door-to-balloon times. Door-to-balloon time (in minutes) significantly increased during the pandemic (Standardized Mean Difference [SMD]= 0.46; 95% CI: 0.03-0.89). The length of hospital stay was reported by five studies (n=9448). Length of hospital stay (in days) was not significantly longer during the pandemic than before the outbreak (SMD= 0.04; 95% CI: -0.19-0.26).

The COVID-19 pandemic is associated with increased mortality and door-to-balloon delay that might be attributable to the strict infection control measures in outbreak. Studies with a longer follow-up time are needed to investigate the outcomes of STEMI patients.

Adjusting the exact warfarin dose has always been challenging since it has a narrow therapeutic window. Numerous factors, including poor drug compliance, drug-drug interactions, and malabsorption syndromes, affect the warfarin plasma concentration, leading to oversensitivity or resistance to warfarin. Patients who need more than 15 mg/d of warfarin for maintained anticoagulant effects are considered warfarin resistant.
We describe a 62-year-old man referred to our center with bruising on his feet in June 2021. The patient had a history of valve replacement (mechanical prosthetic valves in 2013), hypothyroidism, and atrial fibrillation. He presented with warfarin resistance (first noticed in 2013) and did not reach the desired warfarin therapeutic effect despite receiving 60 mg of warfarin daily.
Upon admission, the patient was on warfarin (100 mg/d) with an international normalized ratio (INR) of 1.5. He underwent laboratory and molecular genetic tests, which showed no mutation in the CYP2C9 and VKORC1, the genes associated with warfarin resistance.
A stepwise diagnosis is required to identify the underlying cause. Assessing the patient’s compliance, drug history, dietary habits, malabsorption diseases, and genetics may be necessary. We evaluated these possible reasons for resistance and found no correlation. The patient’s warfarin intake was monitored closely to reach the INR therapeutic target of 3-3.5. He decided to leave the hospital with personal consent. He was discharged with a cardiologist referral and 24 warfarin tablets daily (120 mg/d) with an INR of 1.8. The patient was followed up 6 months and 2 years after discharge and was on the same daily dose of warfarin as at discharge, with no complications.

Nonischemic functional mitral regurgitation (FMR) is accompanied by dire long-term consequences. The treatment revolves around correcting the underlying left ventricular dysfunction. This study reports the long-term adverse outcomes of nonischemic FMR.

We enrolled 200 patients with at-least-moderate nonischemic FMR undergoing medical treatment and/or cardiac resynchronization therapy between 2003 and 2019. MR severity and left ventricular dysfunction parameters were obtained. The endpoint outcomes were all-cause mortality, stroke, all-cause rehospitalization, and the need for heart transplantation. 

Two hundred participants, 104 men (52%) and 96 women (48%), with a median age of 61 years (interquartile range [IQR], 50-70) at diagnosis and a median follow-up of 2 years (IQR, 1-4), were enrolled. All-cause mortality, all-cause rehospitalization, and need for heart transplantation were significantly associated with lower left ventricular ejection fraction and tricuspid annular plane systolic excursion (TAPSE) at diagnosis (P < 0.05). Baseline MR severity was significantly associated with stroke (P = 0.026) and all-cause rehospitalization (P < 0.001).MR severity, New York Heart Association (NYHA) classification, left ventricular end-diastolic diameter, and TAPSE improved at follow-up (P < 0.001). ACEi/ARB (P = 0.008), nitrate (P = 0.001), and hydralazine (P = 0.006) were associated with MR severity improvement. A significant difference was observed between survival free of all-cause mortality according to left ventricular ejection fraction (P = 0.041).

We reported freedom from all-cause mortality, cardiac mortality, and composite endpoints (all-cause mortality, heart transplantation, and stroke) in nonischemic FMR patients. We detected a significant decline in MR severity and NYHA classification during follow-up. Overall, the FMR-associated mortality risk can be significantly reduced by adhering to treatment guidelines in a tertiary heart center. (Iranian Heart Journal 2024; 25(1): 27-41)

We compared the mitral regurgitation (MR) volume measured between 2

the 2D continuity equation transthoracic echocardiography (2D CE-TTE) and the 3D HeartModel transthoracic echocardiography (3D HM-TTE).

Thirty-five patients at a mean age of 53.31 years (SD=15.16) were enrolled. All the patients were diagnosed with severe MR via transesophageal echocardiography. For the comparison of the MR volumes yielded by the 2 methods, the Bland–Altman chart and linear regression analyses were conducted.

The Bland–Altman analysis showed a mean difference of −89.30 mL between the MR volume measurements of the 2 methods, and the linear regression resulted in a standardized coefficient β of −0.831 (P<0.001). Hence, the analysis showed a significant proportional bias between 2D CE-TTE and 3D HM-TTE.

Overall, we observed that 2D CE-TTE overestimated the MR volume measured by 3D HM-TTE by about 30%.

The catheter ablation of idiopathic ventricular arrhythmias is accepted as a first-line treatment as it successfully eliminates about 90.0% of such arrhythmias. One of the most challenging ventricular arrhythmias originates from the left ventricular summit (LVS), a triangular epicardial space with the left main bifurcation as its apex. This area accounts for about 14.0% of LV arrhythmias. The complex anatomy of this region, accompanied by proximity to the major epicardial coronary arteries and the presence of a thick fat pad in this region, renders it a challenging area for catheter ablation. This article presents a review of the anatomy of the LVS and relevant regions and discusses novel mapping and ablation techniques for eliminating LVS ventricular arrhythmias. Additionally, we elaborate on the electrocardiographic (ECG) manifestations of arrhythmias from the LVS and their successful ablation via the direct approach and the adjacent structures.

The aim of this study was to review studies that investigate the factors affecting adherence to treatment in people with cardiovascular disease.

Adherence to treatment is a comprehensive term that is used to convey acceptance of treatment process and following professional advice by the patient to increase the quality of life. Given the importance of adhering to treatment plans and being aware that many people do not follow treatment plans, understanding the factors that lead to patients' effective adherence to the treatment regimen can lead to the development of strategies to increase patients' adherence to the therapeutic regimen.

Articles published between years 2010-2020 were searched out in databases Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc and Magiran using the keywords adherence to treatment, cardiovascular diseases and their Persian Equivalents. Research articles in Persian and English focusing on the factors affecting the adherence to treatment in cardiovascular patients were selected for the study. In total, 167 articles were found in primary search by reviewing the title and abstract and in some cases after studying the full text of the articles; out of them, 11 were selected that were in accordance with the research purpose of this study.

The most effective methods for improving adherence to treatment were tele-nursing and educating colleagues on how to follow up patients. Also, recognizing differences between personal and psychological aspects of patients and adopting an appropriate method for each person to pursue treatment and increase adherence to the treatment regimen are very important known factors in the care of cardiovascular patients.

In general, the care and training provided and continuous follow-up by the health care professionals have the greatest impact on increasing adherence to the treatment regimen among patients.